Factors Associated with Human Papillomavirus Vaccine Uptake Among Secondary School Girls in Ubungo, Dar es Salaam: An Analytical Cross-Sectional Study

Abstract

Background: Human papillomavirus (HPV) vaccination is a key primary prevention strategy for cervical cancer, yet
vaccine completion remains uneven in many low- and middle-income settings. In Tanzania, HPV vaccination has been
delivered through school-based, health-facility-based, and community outreach platforms. Local evidence is needed to
understand uptake and barriers among in-school adolescents in urban settings.
Methods: An analytical cross-sectional study was conducted among 500 secondary school girls aged 14 to16 years in
Ubungo Municipal Council, Dar es Salaam, Tanzania. Participants were selected using a two-stage sampling procedure
from government and private secondary schools. Data were collected using a structured self-administered questionnaire.
Full HPV vaccination was defined as self-reported receipt of two HPV vaccine doses. Frequencies and percentages were
used to describe vaccination status and reported barriers. Logistic regression was used to identify factors associated with
full vaccination.
Results: Overall, 121 girls (24.2%) had received two HPV vaccine doses, 98 (19.6%) had received one dose, and
281 (56.2%) had never received the HPV vaccine. Full vaccination increased with age and class level. In multivariable
analysis, full vaccination was independently associated with age 16 years (aOR 3.73, 95% CI 1.77 to 8.26), Form 4
class level (aOR 4.88, 95% CI 1.65 to 12.77), basic HPV vaccine knowledge (aOR 5.38, 95% CI 2.32 to 12.46),
health-facility visit in the previous six months (aOR 2.06, 95% CI 1.21 to 3.51), and healthcare-provider encouragement
(aOR 2.79, 95% CI 1.59 to 4.87). Among 110 never-vaccinated girls who were unwilling to receive HPV vaccine, the
most common barriers were wanting more information (80.0%), parental or guardian refusal (58.2%), fear of side effects
(56.4%), fluctuating vaccine availability (46.4%), and not knowing where to obtain the vaccine (43.6%).
Conclusion: Full HPV vaccination coverage among secondary school girls in Ubungo Municipal Council was low. Uptake
was influenced by age, class level, HPV vaccine knowledge, recent contact with health services, and encouragement
from healthcare providers. Among unvaccinated girls who were unwilling to receive the vaccine, the main barriers
were informational gaps, parental influence, safety concerns, and difficulties navigating vaccination services. Improving
HPV vaccination in similar urban settings in Tanzania will require practical adolescent-focused education, targeted
communication with parents, strong and consistent recommendations from trusted healthcare providers, and better
coordination of vaccination services across both government and private schools.